Validation of a proxy-reported SARC-F questionnaire for current and retrospective screening of sarcopenia-related functional impairments.

BACKGROUND: The strength, assistance walking, rise from a chair, climb stairs, and falls (SARC-F) questionnaire is a well-established instrument for screening of sarcopenia and sarcopenia-related functional impairments. As it is based on self-reporting, its use precludes patients who are unable to answer the questionnaire as a consequence of severe acute diseases or cognitive impairment. Therefore, we aimed to validate a proxy-reported version of the SARC-F for both ad-hoc as well as retrospective screening for severe sarcopenia-related functional impairments. METHODS: Patients aged ≥60 years completed the SARC-F and performed the short physical performance battery (SPPB) at baseline (T1). Proxies in Cohort A gave a simultaneous assessment of the patients' functional status with the proxy-reported SARC-F at T1 and again, retrospectively, after 3 months (T2). Proxies in Cohort B only completed the SARC-F retrospectively at T2. The questionnaires' performances were assessed through sensitivity/specificity analyses and receiver operating characteristic (ROC) curves. For non-inferiority analyses, results of both the patient-reported and proxy-reported SARC-F were correlated with the SPPB total score as well as the results of the chair-rise test subcategory; the respective correlation coefficients were tested against each other. RESULTS: One hundred and four patients and 135 proxies participated. Using a SPPB score < 9 points as the reference standard, the proxy-reported SARC-F identified patients at high risk for sarcopenia-related functional impairment with a sensitivity of 0.81 (ad-hoc), 0.88 (retrospective Cohort A), and 0.87 (retrospective Cohort B) as well as a specificity of 0.89 (ad-hoc), 0.78 (retrospective Cohort A), and 0.64 (retrospective Cohort B). Areas under the ROC curves were ≥ 0.9 for the ad-hoc proxy-reported SARC-F and the retrospective proxy-reported SARC-F in both cohorts. The proxy-reported SARC-F showed a non-inferior correlation with the SPPB compared with the patient-reported SARC-F for ad-hoc (P = <0.001) as well as retrospective screening for severe sarcopenia-related functional impairment in both Cohorts A (P = 0.007) and B (P = 0.026). CONCLUSIONS: Proxy-reported SARC-F is a valid instrument for both ad-hoc as well as retrospective screening for sarcopenia-related functional impairment and could become the standard tool for evaluating this risk in older adults with severe acute disease, for example, in patients with quickly evolving haematological conditions.

Treatment of sarcopenia in nursing home residents: a scoping review protocol.

INTRODUCTION: Sarcopenia has been recognised as a disease that is consistently associated with a range of geriatric syndromes and negative health consequences. The prevalence of sarcopenia is high among nursing home residents. Several systematic reviews have assessed the efficacy of a range of treatment strategies against sarcopenia. However, no systematic review discussing specifically the treatment options for sarcopenic nursing home residents has been conducted so far. The objective of this scoping review, therefore, is to identify and map existing studies that assessed the feasibility and effectiveness of interventions that were conducted with the aim to treat sarcopenic nursing home residents. METHODS AND ANALYSIS: The protocol was developed using an established scoping review methodological framework. A systematic search of relevant literature databases will be conducted. We will also conduct a search of ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform Search Portal for ongoing and recently completed trials, and will search for grey literature. Two reviewers will independently screen titles and abstracts for inclusion, followed by screening of the full text of potentially relevant articles to determine final inclusion. A data extraction sheet will be developed including key study characteristics that will be relevant for collating, summarising and reporting the results of the scoping review. ETHICS AND DISSEMINATION: The proposed scoping review will undertake a secondary analysis of publicly available data, and therefore does not require ethical approval. The results will be disseminated to researchers in the field by submitting the review to a peer-reviewed international journal and by presenting our findings at relevant conferences. We expect that the results of the final review will help to guide future research in the field of sarcopenia treatment for nursing home residents.

Dietary weight-loss interventions for the management of obesity in older adults.

The obesity epidemic has reached old age in most industrialized countries, but trials elucidating the benefits and risks of weight reduction in older adults above 70 years of age with obesity remain scarce. While some findings demonstrate a reduced risk of mortality and other negative health outcomes in older individuals with overweight and mild obesity (i.e. body mass index (BMI) < 35 kg/m2), other recent research indicates that voluntary weight loss can positively affect diverse health outcomes in older individuals with overweight and obesity (BMI > 27 kg/m2), especially when combined with exercise. However, in this age group weight reduction is usually associated with a reduction of muscle mass and bone mineral density. Since uncertainty persists as to which level overweight or obesity might be tolerable (or even beneficial) for older persons, current recommendations are to consider weight reducing diets only for older persons that are obese (BMI ≥ 30 kg/m2) and have weight-related health problems. Precise treatment modalities (e.g. appropriate level of caloric restriction and indicated dietary composition, such as specific dietary patterns or optimal protein content) as well as the most effective and safest way of adding exercise are still under research. Moreover, the long-term effects of weight-reducing interventions in older individuals remain to be clarified, and dietary concepts that work for older adults who are unable or unwilling to exercise are required. In conclusion, further research is needed to elucidate which interventions are effective in reducing obesity-related health risks in older adults without causing relevant harm in this vulnerable population.

Methods to Assess Patient Preferences in Old Age Pharmacotherapy - A Systematic Review.

PURPOSE: The aim of this systematic review was to identify methods used to assess medication preferences in older adults and evaluate their advantages and disadvantages with respect to their applicability to the context of multimorbidity and polypharmacy. MATERIAL AND METHODS: Three electronic databases (PubMed, Web of Science, PsycINFO) were searched. Eligible studies elicited individual treatment or outcome preferences in a context that involved long-term pharmacological treatment options. We included studies with a study population aged ≥ 65 years and/or with a mean or median age of ≥ 75 years. Qualitative studies, studies assessing preferences for only two different treatments, and studies targeting preferences for life-sustaining treatments were excluded. The identified preference measurement methods were evaluated based on four criteria (time budget, cognitive demand, variety of pharmacological aspects, and link with treatment strategies) judged to be relevant for the elicitation of patient preferences in polypharmacy. RESULTS: Sixty articles met the eligibility criteria and were included in the narrative synthesis. Fifty-five different instruments to assess patient preferences, based on 24 different elicitation methods, were identified. The most commonly applied preference measurement techniques were "medication willingness" (description of a specific medication with inquiry of the participant's willingness to take it), discrete choice experiments, Likert scale-based questionnaires, and rank prioritization. The majority of the instruments were created for disease-specific or context-specific settings. Only three instruments (Outcome Prioritization Tool, a complex intervention, "MediMol" questionnaire) dealt with the broader issue of geriatric multimorbidity. Only seven of the identified tools showed somewhat favorable characteristics for a potential use of the respective method in the context of polypharmacy. CONCLUSION: Up to now, few instruments have been specifically designed for the assessment of medication preferences in older patients with multimorbidity. To facilitate valid preference elicitation in the context of geriatric polypharmacy, future research should focus on suitable characteristics of existing techniques to develop new measurement approaches for this increasingly relevant population.

Outcome Priorities for Older Persons With Sarcopenia.

OBJECTIVES: To evaluate patients' preferences for sarcopenia outcomes. DESIGN: Discrete-choice experiment (DCE) SETTING AND PARTICIPANTS: Community-dwelling individuals older than 65 years suffering from sarcopenia recruited in Belgium, France, Germany, Italy, Spain, and Switzerland, who visited the clinic and were cognitively able to understand and fill out the survey. METHODS: In the DCE survey, participants were repetitively asked to choose which one of the 2 patients suffering from sarcopenia deserves treatment the most. The 2 patients presented different levels of risk for 5 preselected sarcopenia outcomes: quality of life, mobility, domestic activities, fatigue, and falls. The DCE included 12 choice sets. Mixed logit panel model was used to estimate patients' preferences and latent class model was conducted to identify profiles of responses. RESULTS: A total of 216 sarcopenic persons were included for the analysis (68% women; mean age 78 years). All 5 preselected sarcopenia outcomes were shown to be significant. Overall, the most important sarcopenia outcome was mobility (30%), followed by the ability to manage domestic activities (22%), the risk of falls (18%), fatigue (17%), and quality of life (14%). The latent class model identified 2 classes of respondents. In the first class (probability of 56%), participants valued mobility the most (42%), followed by the ability to manage domestic activities (23%) and risk of falls (17%). In the second class, fatigue was the most important outcome (27%) followed by domestic activities (19%) and risk of falls (19%). No statistically significant associations between the latent classes and sociodemographic characteristics were found. CONCLUSIONS AND IMPLICATIONS: This study suggests that all 5 preselected outcomes were important for sarcopenic older individuals. Overall, the most important outcomes were mobility and the ability to manage domestic activities, although variations in preferences were observed between respondents. This could help in incorporating patient preferences when designing appropriate solutions for individuals with sarcopenia.

Management of Malnutrition in Older Patients-Current Approaches, Evidence and Open Questions.

Malnutrition is widespread in older people and represents a major geriatric syndrome with multifactorial etiology and severe consequences for health outcomes and quality of life. The aim of the present paper is to describe current approaches and evidence regarding malnutrition treatment and to highlight relevant knowledge gaps that need to be addressed. Recently published guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) provide a summary of the available evidence and highlight the wide range of different measures that can be taken-from the identification and elimination of potential causes to enteral and parenteral nutrition-depending on the patient's abilities and needs. However, more than half of the recommendations therein are based on expert consensus because of a lack of evidence, and only three are concern patient-centred outcomes. Future research should further clarify the etiology of malnutrition and identify the most relevant causes in order to prevent malnutrition. Based on limited and partly conflicting evidence and the limitations of existing studies, it remains unclear which interventions are most effective in which patient groups, and if specific situations, diseases or etiologies of malnutrition require specific approaches. Patient-relevant outcomes such as functionality and quality of life need more attention, and research methodology should be harmonised to allow for the comparability of studies.

ESPEN guideline on clinical nutrition and hydration in geriatrics.

BACKGROUND: Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM: To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS: This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS: We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION: A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.

Ready-meal consumption in older people: association with obesity and dietary intake.

OBJECTIVE: To investigate ready-meal consumption trends in older French people, its association with overall diet quality and obesity. DESIGN: Cross-sectional analysis SETTING: Multidomain Alzheimer Preventive Trial (MAPT), France SUBJECTS: 421 MAPT participants (mean age 76.8 years) who filled a food frequency questionnaire. RESULTS: The frequency of ready-meal consumption was low, with nearly 90% of participants declaring consuming ≤ 1 ready-meal per week. Compared to non- and low-consumers (≤ 1 ready-meal/week), regular consumers (≥ 2 ready-meals/week) were older (p < 0.01), more often frail and pre-frail (p 0.04), with impaired cognition (p = 0.02) and functional status (p = 0.02), with more depressive symptoms (p = 0.03) and more difficulties with preparing meals (p = 0.01). Results from multivariate analyses showed that regular ready-meal consumption was not associated with obesity (p = 0.26) and diet quality (p = 0.37). CONCLUSIONS: In our sample, few older people declared consumption of 2 or more ready-meals per week, this consumption was not associated with a higher prevalence of obesity or a lower diet quality, despite the fact that these subject were older, with a lower physical and cognitive status. These findings suggest that, for these people with difficulties in meal preparation, convenience foods consumed occasionally could help to maintain diet quality and weight status.

Prevalence of malnutrition using harmonized definitions in older adults from different settings - A MaNuEL study.

BACKGROUND & AIMS: Malnutrition is widespread among older people and related to poor outcome. Reported prevalences vary widely, also because of different diagnostic criteria used. This study aimed to describe prevalences in several populations of older persons in different settings using harmonized definitions. METHODS: Available studies within the Joint Programming Initiative (JPI) Knowledge Hub 'Malnutrition in the Elderly' (MaNuEL) were used to calculate and compare prevalences of malnutrition indicators: low BMI (<20 kg/m2; age-specific BMI <20 if age 65-<70 and <22 kg/m2 if age ≥70 years), previous weight loss (WL), moderate and severe decrease in food intake, and combined BMI <20 kg/m2 and/or WL in participants aged ≥65 years. RESULTS: Fifteen samples with in total 5956 participants (59.3% women) were included: 7 consisting of community-dwelling persons, 2 studies in geriatric day hospitals, 3 studies in hospitalized patients and 3 in nursing homes. Mean age of participants ranged between 67 and 87 years. Up to 4.2% of community-dwelling persons had a BMI <20 kg/m2, 1.6 and 9% of geriatric day hospital patients, 4.5-9.4% of hospital patients and 3.8-18.2% of nursing home residents. Using age-specific cut-offs doubled these prevalences. WL was reported in 2.3-10.5% of community-dwelling persons, 6% and 12.6% of geriatric day hospital patients, 5-14% of hospitalized patients and 4.5-7.7% of nursing home residents. Severe decrease in food intake was recorded in up to 9.6% of community-dwelling persons, 1.5% and 12% of geriatric day hospital patients, 3.4-34.2% of hospitalized patients and 1.5-8.2% of nursing home residents. The criteria age-specific BMI and WL showed opposing prevalences across all settings. Compared to women, low BMI and moderate decrease in food intake showed low prevalences in men but similar prevalences were observed for weight loss and severe decrease in food intake. In half of the study samples, participants in a younger age group had a higher prevalence of WL compared to those of an older age group. Prevalence of BMI <20 kg/m2 and WL at the same time did not exceed 2.6% in all samples. The highest prevalences were observed based on combined definitions when only one of the three criteria had to be present. CONCLUSIONS: Prevalences for different criteria vary between and within the settings which might be explained by varying functional status. The criteria used strongly affect prevalence and it may be preferable to look at each criterion separately as each may indicate a nutritional problem.

Red blood cell membrane omega-3 fatty acid levels and physical performance: Cross-sectional data from the MAPT study.

BACKGROUND & AIMS: Studies have shown that omega-3 polyunsaturated fatty acids (PUFAs) are associated with brain, cardiovascular and immune function, as well as physical performance and bone health in older adults. So far, few studies have highlighted the associations between PUFA status and performance-based tests of physical function. To study the associations between the omega-3 index (red blood cell (RBC) membrane content of omega-3 PUFAs, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) and physical performance measured with the Short Physical Performance Battery (SPPB) in a sample of community-dwelling older adults. DESIGN: Cross-sectional study using the baseline data of the Multidomain Alzheimer's Disease Trial (MAPT), a randomized, placebo-controlled trial. PARTICIPANTS AND MEASUREMENTS: 1449 participants with available data on PUFAs were included. Omega-3 index and Short Physical Performance Battery (SPPB) scores were measured at enrollment and the omega-3 index expressed as the percentage of total fatty acid content was calculated. We also dichotomized the omega-3 index as low (lowest quartile) vs. high (three upper quartiles). RESULTS: Participants were 75.2 (±4.4) years old, 64.5% were female. Bivariate analyses found that participants who were in the lowest omega-3 index quartile (Q1) had a SPPB score significantly lower than participants in the three other quartiles (Q2-Q4). However, adjusted (for age, gender, cognitive function, depressive status, Body Mass Index and grip strength) multiple linear regression showed that the omega-3 index-SPPB score association did not reach statistical significance [ß = -0.166; (-0.346; 0.013); p = 0.07] in our sample. CONCLUSION: This cross-sectional study found that participants with a low omega-3 index had worse performance-based test results of physical function than people with a high omega-3 index, but this association did not reach statistical significance once confounders were controlled for. Studies looking at the over-time associations between PUFA status and physical performance changes may shed more light on this topic.

Omega-3 fatty acid levels in red blood cell membranes and physical decline over 3 years: longitudinal data from the MAPT study.

Studies have shown that omega-3 polyunsaturated fatty acids (PUFAs) are associated with brain, cardiovascular, and immune function, as well as physical performance and bone health in older adults. So far, few studies have investigated the associations between PUFA status and performance-based tests of physical function. The objective of this study was to investigate the associations between the omega-3 PUFA levels (eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA)) in red blood cell (RBC) membranes and physical performance, in a sample of community-dwelling older adults. This is a longitudinal observational study using data from the Multidomain Alzheimer's Disease Trial (MAPT), a randomized, placebo-controlled trial. Four hundred participants from MAPT placebo group with available PUFA data were included. Omega-3 PUFA levels in RBC membranes were measured at baseline, and their percentage of total RBC membrane fatty acid content was calculated. We dichotomized the standardized omega-3 PUFA levels in RBC membranes as low (lowest quartile) vs. high (three upper quartiles). Gait speed (in m/s) and short physical performance battery (SPPB) score (range from 0 to 12, higher is better) were used to assess physical performance at baseline and after 6, 12, 24, and 36 months. Participants were 75.2 (± 4.3) years old and 68% were female. Bivariate analyses found that the characteristic of the participants in the lowest quartile of omega-3 PUFA levels (Q1) and those in the three upper quartiles (Q2-Q4) was not different at baseline; only those in Q1 were slightly older. In an unadjusted model, the difference in gait speed after 3 years of follow-up was significant (- 0.09 ± 0.03 m/s; p = 0.008) between participants in Q1 and those in Q2-Q4. In a model adjusted for age, gender, educational level, cognitive function, depressive status, body mass index, physical activity, grip strength, and their time interaction, this difference remained clinically relevant (- 0.07 ± 0.04 m/s; p = 0.075). No difference between the two groups was found for the SPPB score development over 3 years. Older adults with subjective memory complaints and in the lower quartile of omega-3 have a faster decline on gait speed compared to people in the three upper quartiles. Other longitudinal studies are needed to explore this association and to examine mechanisms.

Prevalence of sarcopenia in Germany and the corresponding effect of osteoarthritis in females 70 years and older living in the community: results of the FORMoSA study.

BACKGROUND: Although sarcopenia represents a challenging burden for health care systems around the world, its prevalence in the elderly population varies widely. The primary aim of the study was to determine the prevalence of sarcopenia in community-dwelling (CD) German women aged 70 years and older; the secondary aim was to assess the effect of osteoarthritis (OA) on sarcopenia prevalence in this cohort. METHODS: A total of 689 Caucasian females 18-35 years old and 1,325 CD females 70 years+ living in Northern Bavaria, Germany, were assessed during the initial phase of the FORMoSA research project. Anthropometry, total and regional muscle mass, were assessed by segmental multifrequency Bioelectrical Impedance Analysis. Further 10 m walking speed and handgrip strength were evaluated to apply the European Working Group on Sarcopenia in Older People definition of sarcopenia. Covariates were determined by questionnaires and interviews. RESULTS: Applying the algorithm of the European Working Group on Sarcopenia in Older People of two standard deviations below the mean value for appendicular skeletal muscle mass of a reference cohort of the young cohort (5.66 kg/m(2)), low gait speed (≤0.8 m/s), and low grip strength (<20 kg), the prevalence of sarcopenia in CD German females 70 years and older was 4.5% (70-79 years: 2.8% vs ≥80 years: 9.9%; P<0.001). Participants with OA at the hip and lower limbs (n=252) exhibited significantly higher rates of sarcopenia (OA: 9.1 vs non-OA: 3.5%). Of importance, anthropometric, demographic, health, and lifestyle parameters (except exercise participation) of our cohorts corresponded with Bavarian or German data for CD women 70 years+. CONCLUSION: The prevalence of sarcopenia in CD German females 70 years+ is relatively low. However, participants with OA at the hip or lower limbs were at increased risk for sarcopenia.

Sarcopenic obesity and complex interventions with nutrition and exercise in community-dwelling older persons--a narrative review.

One of the many threats to independent life is the age-related loss of muscle mass and muscle function commonly referred to as sarcopenia. Another important health risk in old age leading to functional decline is obesity. Obesity prevalence in older persons is increasing, and like sarcopenia, severe obesity has been consistently associated with several negative health outcomes, disabilities, falls, and mobility limitations. Both sarcopenia and obesity pose a health risk for older persons per se, but in combination, they synergistically increase the risk for negative health outcomes and an earlier onset of disability. This combination of sarcopenia and obesity is commonly referred to as sarcopenic obesity. The present narrative review reports the current knowledge on the effects of complex interventions containing nutrition and exercise interventions in community-dwelling older persons with sarcopenic obesity. To date, several complex interventions with different outcomes have been conducted and have shown promise in counteracting either sarcopenia or obesity, but only a few studies have addressed the complex syndrome of sarcopenic obesity. Strong evidence exists on exercise interventions in sarcopenia, especially on strength training, and for obese older persons, strength exercise in combination with a dietary weight loss intervention demonstrated positive effects on muscle function and body fat. The differences in study protocols and target populations make it impossible at the moment to extract data for a meta-analysis or give state-of-the-art recommendations based on reliable evidence. A conclusion that can be drawn from this narrative review is that more exercise programs containing strength and aerobic exercise in combination with dietary interventions including a supervised weight loss program and/or protein supplements should be conducted in order to investigate possible positive effects on sarcopenic obesity.

Low postoperative dietary intake is associated with worse functional course in geriatric patients up to 6 months after hip fracture.

We examined the relationship between postoperative dietary intake (DI) of geriatric hip fracture (HF) patients and their functional and clinical course until 6 months after hospital discharge. In eighty-eight HF patients ≥ 75 years, postoperative DI was estimated with plate diagrams of main meals over four postoperative days. DI was stratified as >50, >25-50, ≤ 25 % of meals served. Functional status according to Barthel index (activities of daily living) and patients' mobility level before fracture, postoperatively, at discharge and 6 months later were assessed and related to DI levels. In-hospital complications were recorded according to clinical diagnosis. Associations were evaluated using χ2 and Kruskal-Wallis tests, and repeated-measures ANOVA and ANCOVA. Postoperatively, 28 % of participants ate >50 %, 43 % ate >25-50 % and 28 % ≤ 25 % of meals served. Irrespective of pre-fracture functional status, patients with DI ≤ 25 % had significantly lower Barthel index scores at all times after surgery (all P50 % more often had regained their pre-fracture mobility level than those with DI ≤ 25 % at discharge (>50 %: 36 %; >25-50 %: 10 %; ≤ 25 %: 0 %; P= 0·001) and 6 months after discharge (88; 87; 68 %; P= 0·087) and had significantly less complications (median 2 (25th-75th percentile 1-3); 3 (25th-75th percentile 2-4); 3 (25th-75th percentile 3-4); P= 0·012). To conclude, geriatric HF patients had very low postoperative voluntary DI and thus need specific nutritional interventions to achieve adequate DI to support functional and clinical recovery.

Malnutrition According to Mini Nutritional Assessment Is Associated With Severe Functional Impairment in Geriatric Patients Before and up to 6 Months After Hip Fracture.

OBJECTIVES: Hip fractures (HFs) in old age frequently cause severe functional impairment and deteriorating autonomy in everyday life. Many older patients with HFs are malnourished or at risk of malnutrition. In this study, we examined the relationship between nutritional status of geriatric patients before HF and their functional and clinical course up to 6 months after hospital discharge. DESIGN: Observational study with follow-up after 6 months. SETTING: Four wards of the department of trauma and orthopedic surgery of a large urban maximum care hospital (Klinikum Nürnberg, Nuremberg, Germany). PARTICIPANTS: Geriatric patients aged ≥75 years with surgically repaired proximal femoral fracture. MEASUREMENTS: Prefracture nutritional status was determined by Mini Nutritional Assessment (MNA). Comorbidities and complications during hospital stay were obtained from medical documentation. Functional status before HF, postoperatively, at hospital discharge, and 6 months later was assessed by Barthel Index for activities of daily living (ADL) and patients' mobility level and related to MNA categories. Associations were evaluated using χ(2), Fisher exact, Kruskal-Wallis, Mann-Whitney-U, Jonckheere-Terpstra, and Cochrane-Armitage tests as appropriate, as well as analysis of covariance with repeated measures. RESULTS: Of 97 included patients, 17% were malnourished and 38% at risk of malnutrition before HF. Participants with (risk of) malnutrition were equally mobile but more dependent in ADL prior to HF than well-nourished patients (P < .001). Independent of nutritional status, after 6 months 68% of participants had not regained their prefracture level of independence in ADL. According to analysis of covariance, the ADL development over time until follow-up 6 months after hospital discharge did not depend on nutritional status. However, at follow-up malnourished patients more often suffered from remaining losses in ADL ≥25% of initial Barthel Index points (P = .033) and less often had regained their prefracture mobility level (P = .020) than well-nourished patients. Clinical course did not differ significantly between the groups with different nutritional status. CONCLUSIONS: In this study with geriatric HF patients from all functional and cognitive levels, worse prefracture nutritional status was associated with worse functional status and more frequent remaining functional loss, whereas the trajectory of ADL recovery and clinical course did not differ significantly. Further studies with sufficient statistical power are needed to substantiate these inconclusive results. In order to clarify the association of nutritional status with functional and clinical course in geriatric patients after HF, they should preferably focus on the role of nutritional management during the hospital stay.